Core knowledge content

Transcription

1 Core knowledge content The content in this section is meant to provide the teacher with the background information needed to prepare and teach the Grade 8 substance misuse class. Definition of drug A drug is a substance, other than food, which changes the way a person thinks, feels, and acts. A drug can come from a plant or can be made in a laboratory. A drug can enter the body by being ingested, smoked, injected, inhaled, or absorbed (e.g. under the tongue or through the skin). Why people use drugs Young people may be tempted to try drugs and alcohol because of peer pressure and their desire to fit in. Curiosity, rebellion, and boredom are other reasons young people may use drugs. Portrayal of drug and alcohol use in movies, commercials, or TV shows may glamourize drug use and downplay the negative consequences. Individuals experiencing stress or mental health concerns may turn to drugs/alcohol as a way to escape or relax. Levels of drug use Level of use Key features Non-Use Never used a drug Experimental Curious about effects of drug; used several times Irregular Infrequent use; special occasion When opportunities are available Regular Regular use Friends are doing it Feels in control of drug use

2 Level of use Key features Dependent (Addiction) Craving Loss of control of amount or frequency of use Compulsion to use Use despite consequences Addiction and abuse potential The word addiction is often used to refer to any behaviour that is out of control in some way. People often describe themselves as being addicted to, for example, a TV show or shopping. The word is also used to explain the experience of withdrawal when a substance or behaviour is stopped, e.g. I must be addicted to coffee: I get a headache when I don t have my cup in the morning. However, experiencing enjoyment or going through withdrawal do not in themselves mean a person has an addiction. Because the term addiction is commonly used in such a vague way, there have been many attempts to define it more clearly. One simple way of describing addiction is the presence of the 4 Cs: craving loss of control of amount or frequency of use compulsion to use use despite consequences Additional warning signs of substance misuse may include: changes in behaviour gradual withdrawal from social circles drop in grades loss of interest in normal activities

3 Stimulants Stimulants and depressants are a classification of drugs that alter how the brain functions and works. This can result in affecting how people feel and act. Stimulants increase mental and physical functions, such as alertness and heart rate. Stimulants are chemicals that elevate mood, alertness, and energy. Short-term side effects: At low doses, stimulants narrow blood vessels in the body, which causes a decrease in blood flow and oxygen to the heart, at the same time causing an increase in blood pressure and heart rate. Stimulants also increase body temperature and breathing rate, as well as decrease the ability to sleep and the desire to eat. Other short-term effects can include sweating, dilated pupils, restlessness, aggressive behaviour, dizziness, tremors, increased ability to concentrate, paranoia, and hallucinations. Long-term side effects: Repeated use of stimulants can lead to feelings of hostility and paranoia. At high doses, they can lead to serious cardiovascular complications including heart attack, stroke, and seizures. Longterm use can lead to the development of tolerance, which can lead to reduced effects of the drug. This may prompt the user to increase the dose to reinstate the desired effects. The potential for dependence and addiction increases with repeated use of higher doses. The abuse of stimulants can alter a person s judgment and decision-making ability, which can increase the likelihood of engaging in risky behaviours. If stimulants are used chronically, withdrawal symptoms including fatigue, depression, and disturbed sleep patterns can emerge when the drugs are discontinued. Examples of stimulants include caffeine, nicotine, steroids, ecstasy (MDMA), cocaine, and methamphetamines. Depressants Depressants have a relaxing effect and can slow physical functions, such as breathing. Stimulants and depressants can be found in food components, prescription medicines, and illicit drugs. Like many other drugs that affect the brain, many stimulants and depressants are addictive and may have serious side effects. Depressants slow activity of the brain and body. They are used medically to help control anxiety, sleeplessness, and seizures. They also reduce heart and breathing rates, blood pressure, muscle

4 tension, and pain. The muscle relaxation and sedation these drugs cause make them useful during certain Substance medical procedures. Misuse Grade 8 Examples of depressants include alcohol, tranquilizers, narcotic analgesics, and sedative hypnotics. Warnings and precautions Stimulants and depressants may negatively affect health and well-being. If the drug has been prescribed by a doctor, the drug must be used exactly as recommended. Using high doses of these drugs, mixing them simultaneously, and/or combining stimulants or depressants with other drugs or alcohol increase the risk for side effects. Side effects may include panic attacks, hallucinations, paranoia, hostile behavior, depression, sleep and appetite problems, overdose and death. Some side effects of stimulants and/or depressants require immediate medical attention, including: shortness of breath, chest pain, dizziness or fainting hearing and believing things that are not real profuse sweating with chills dwelling of the tongue or throat, and trouble breathing seizures or loss of consciousness Alcohol Alcohol is often thought of as a stimulant, but is actually a depressant that slows down brain functions, breathing and heart rate. The effect that alcohol has on your health depends on many factors, including your weight, sex, age, overall health, drinking patterns, and the amount of your drink. Women, seniors, and adolescents tend to be more strongly affected by alcohol than men because typically they are smaller and have less of the liver enzyme that breaks down alcohol. Young people are especially vulnerable to the effects of alcohol. This is because their brains and bodies and still developing. They also tend to be less familiar with the effects of alcohol, and are more likely to do something impulsive or dangerous. The younger a person starts drinking, the more likely they are to experience problems with alcohol and poor health. Binge drinking Researchers define binge drinking as five or more standard drinks on one occasion for males;

5 four or more standard drinks on one occasion for females. A standard drink is defined as: Binge drinking can cause a hangover (headache, nausea/vomiting, and shakiness) and/or alcohol poisoning. Symptoms of alcohol poisoning include slow breathing, vomiting, confusion, shakiness, slow/weak pulse, and/or cold/clammy, pale or bluish skin. Individuals with alcohol poisoning may also lose consciousness (pass out). Alcohol poisoning is a medical emergency. Alcohol slows breathing and heart rate. If either slows too much then it can result in death. Alcohol also slows down brain and body functions. The body will naturally try to get rid of the poison (alcohol) by vomiting. This could be dangerous or even fatal for individuals who are passed out as they could choke on their own vomit. Check if person is breathing. Check for pulse. Never leave an unconscious person alone. Turn them on their side (Bacchus Maneuver) and call 911. Make sure that person returns to confirm that they called. If no one else is around, call 911 and return to the victim. Give nothing by mouth (no coffee). Don t leave person alone, the risk for injuries is high. Notify parent/guardians. Consequences of drinking alcohol Alcohol slows down brain and body functions that can result in poor decision making and decreased coordination. As a result, individuals are more likely to experience fights, sexual assault, and injuries when they have been drinking alcohol. Motor vehicle accidents (including car, boats, ATVs) are more likely after consuming alcohol due to its effects on reaction time and vision. Planning a safe ride home can help decrease this risk. Drinking alcohol can also affect athletic performance due to hangovers, weight gain, and decreased motor skills. Alcohol use has also been associated with poor grades and students who drink dangerously are more likely to drop out of school.

6 Alcohol use during pregnancy can result in Fetal Alcohol Spectrum Disorder (FASD) in the infant. FASD Substance is a preventable Misuse developmental Grade disability 8 that affects the infant physically, cognitively, emotionally, and/or behaviourally. Some individuals may develop an addiction to alcohol. Long-term alcohol use may result in damage to organs including the liver, pancreas, stomach, and/or brain. Long-term alcohol use has also been linked to an increased risk for many types of cancer. Hallucinogens Hallucinogens are a group of drugs that may cause an individual to see, hear, or feel things that are not really there. They distort the way a user perceives time, motion, colours, sounds, and self. These drugs can disrupt a person s ability to think and communicate rationally, or even to recognize reality, sometimes resulting in bizarre or dangerous behaviour. The effects of hallucinogens on an individual vary depending on a number of factors including a person s size, weight, sex, age, and physical and mental health. The type, quantity, frequency, and duration of drug use will also influence the way a person responds to the drug. Mixing any drugs with other drugs and/or alcohol can further alter a person s response to the drug. As a result, individual s experiences with hallucinogens are often unpredictable. A person using hallucinogens may experience sensations that are enjoyable and mentally stimulating and that produce a sense of heightened understanding. However, individuals may also have negative experiences or bad trips, including terrifying thoughts and nightmarish feelings of anxiety and despair that include fears of losing control, insanity, or death. Taking hallucinogens can be dangerous for several reasons. They distort thoughts and can cause paranoia which can lead to unusual and dangerous behavior. They are often illegal and unregulated which means they may contain other drugs or toxins. The effects of drugs use on the body will again vary depending on type and quantity, but may include such negative effects as increased heart rate, elevated blood pressure, elevated body temperature, paranoia, anxiety, and nervousness. Some hallucinogenic plants may be mistaken for lethal plants (i.e. mushrooms). If used during pregnancy, drugs may affect the development of the baby and increase chance for miscarriage. Long-term use of hallucinogens may result in persistent psychosis which is characterized with visual and mood disturbances, paranoia, and disorganized thinking. Examples of hallucinogens include LSD, mescaline, psilocybin, PCP, cannabis, ecstasy (MDMA), ketamine, and salvia.

7 Cannabis (marijuana, hashish) Cannabis (marijuana) comes from the cannabis sativa plant and contains the chemical THC (Tetrahydrocannabinol). THC is the main mind altering ingredient in the plant. The amount of THC determines its potency or strength. The THC content of cannabis has been increasing over the past few decades. When someone consumes cannabis, THC acts in the brain to produce its effects. If consumed by being smoked, THC passes quickly from the lungs into the bloodstream which carries the chemical to the brain and other organs in the body. Cannabis can be laced with more than 400 potentially dangerous substances Street names of cannabis include marijuana, grass, weed, pot, dope, ganja, hashish, hash, hash oil, weed oil, and honey oil. Cannabis is usually smoked as a cigarette (joint), in a pipe, electronic cigarettes (vapes). Cannabis can also be smoked in blunts, which are cigars that have been emptied of tobacco and refilled with a mixture of tobacco and cannabis. This method combines the dangerous chemicals of cannabis with nicotine and other harmful chemicals. Hashish is a more concentrated and viscous form of cannabis; and hash oil is a sticky, black liquid. Cannabis can also be ingested (e.g. in baked goods). Youth are at higher risk for negative health effects associated with cannabis use. This is why Canada s lower-risk cannabis use guidelines (2017) recommend youth abstain from cannabis use. For those who choose to use cannabis despite known health risks, it is important to know that the negative effects can be reduced by delaying initiation of cannabis use. Several studies have shown a link between chronic cannabis (marijuana) use and increased rates of anxiety, depression, and schizophrenia. Some of these studies have shown age at first use to be an important risk factor. Cannabis increases heart rate by % shortly after smoking. Increased heart rate, heart palpitations, and arrhythmias can lead to increased risk of heart attacks in users. The smoke from cannabis contains carcinogens and is an irritant to lungs. Cannabis smokers can have many of the same respiratory problems as tobacco smokers, such as chronic cough, phlegm production, and increase in chest and lung infections. Use of marijuana and other cannabis products has potential to cause problems in daily life or worsen existing problems. Physical and mental health, cognitive abilities, social life, and school/career can be negatively affected. Intoxication leads to decreased concentration, disorientated behavior, loss of coordination, distortions in perception and depth, which can lead to

8 poor decision making. It is dangerous to drive, operate machinery, or play sports when under the influence Substance of cannabis. Misuse Grade 8 Long-term abuse of cannabis can lead to addiction. Research estimates approximately 9% of users become addicted to cannabis (marijuana). This number increases among those who start young to approximately 17%, and among daily users to 25-50% (National Institute on Drug Abuse). According to the Ontario Student Drug Use and Health Survey (2015), 21.3% of students report using cannabis in the last year. This means that more than three quarters of students do not use cannabis. Recreational cannabis became legal on October 17, You must be 19 years of age and older to buy, use, grow or possess cannabis. For more information about cannabis legalization refer to supplemental knowledge section.

9 Designer drugs This classification of drugs are man-made (synthetically produced), illegal drugs and are not regulated. The contents are often unknown. They are sometimes referred to as a club drug because these types of drugs are sometimes taken at clubs or raves. They may also be known as rape drugs. It can be easily slipped into a drink. It will not change the colour or taste of the drink, but can cause quick intoxication and can be used for sexual assault. Individuals should never leave their drink alone. Examples of designer drugs include Rohypnol ( roofies ), ecstasy (MDMA), Gamma Hydroxyburtyric Acid (GHB or liquid ecstasy ) and ketamine ( Special K ). Non-medical use of prescription drugs The non-medical use of prescription drugs is when someone takes another person s prescription medication to get high. Taking prescription drugs without a doctor s supervision (that are not prescribed to you), can be just as dangerous as using illegal/illicit drugs. Prescription drugs are considered to be legal when they are prescribed to you by a doctor. However, taking these types of medications when they have not been prescribed to you is considered illegal. Prescription drugs have side effects even when used as prescribed. When prescription drugs are used without doctor s supervision and/or combined with other drugs/alcohol the side effects can increase. The side effects could even be life threatening (i.e. opioids affect the part of the brain responsible for breathing and so do other depressants such as alcohol.) Combined, an individual could stop breathing. Tolerance may develop with many prescription drugs (i.e. opioids). This means that an individual would gradually need to take more of a drug to achieve the same effect. This increases risk for overdose. Opioids and other prescription drugs can be highly addictive. According to the 2015 Ontario Student Drug Use and Health Survey, 10% of students (Grades 7-12) reported using prescription opioids (pain relievers) for non-medical purposes. Examples: Percocet, Oxycontin, Tylenol #3.

10 Mental health and substance abuse Problematic substance use and mental illness can be closely connected. The presence of a mental illness such as depression, psychosis, and personality disorder, have been found to have links to substance abuse/misuse. In addition, traumatic events, grief or loss, and social isolation may also lead to substance misuse. Mental illness may contribute to problematic substance use. OR Drug use can lead to the development of mental illnesses. Substance misuse can cause changes in a person s life that result in serious and prolonged distress. This distress can contribute to the onset of mental health problems. Warning signs of substance abuse: changes in behaviour gradual withdrawal from social circles drop in grades loss of interest in normal activities Where to get help Kids Help Phone ( ) Mental Health Helpline ( or Community Addictions Services of Niagara (CASON) ( ) or Pathstone Mental Health Crisis Services ( ) Al-Anon/Alateen (if you are bothered by someone else s drinking) or Parents Teacher/Principal/Vice-Principal Child and Youth Worker Public Health Nurse Doctor

11 Supplemental knowledge Questions kids have when a parent drinks (Adapted from: When a parent drinks too much alcohol What kids want to know, retrieved from Why does my mom or dad drink so much? Lots of people drink alcohol and don t have problems. But this is not true for everyone. There are many possible reasons why someone may have a problem with alcohol, but sometimes the causes are not known. There are also different reasons why people begin drinking too much. At first, people may drink alcohol because it makes them feel better or more relaxed, or because it seems like fun. Some people may gradually begin to drink more, while for others heavy drinking may start more suddenly. In some cases, stress or other mental health problems may lead a person to drink more alcohol. Remember, not all alcohol use is a problem. It ranges from non problem drinking to addiction. Can you feel bad when you stop drinking or cut back quickly? Yes. People who often drink a lot for a period of time, or binge (five or more drinks on one occasion), may feel bad and even experience serious physical effects when they stop drinking or cut down. These are called withdrawal symptoms. They may: feel nervous and jumpy, have sleep problems, have tremors (the shakes ), have seizures, have hallucinations (think they hear or see things that aren t really there). What does it feel like to drink alcohol? How does it feel to be drunk? Alcohol is a drug. It affects a person s body and how he or she feels and behaves. People who are drunk may have many different feelings. They may feel dizzy, silly, happy or free to act however they want. Or they may feel out of control, angry, violent, sad, tired or nauseous (feel like vomiting). After drinking a lot, people may have trouble remembering, talking, standing, walking or doing other tasks. People may also vomit (throw up), fall down, feel ill (have a hangover ) or black out (when they can t remember what happened).

12 Why am I so confused about how I feel? Why do I worry so much? If someone in your family drinks too much alcohol, things at home might not feel calm or safe. The alcohol problem can make family relationships tense, which can cause arguments. When you are worrying about what is going on, it may be hard to concentrate at home and at school. The parent with the alcohol problem may say things that he or she doesn t mean. Your mom or dad may break promises. There may not be a regular schedule at home (for example, meals may not be on time). You may feel unhappy, or may be embarrassed to bring friends home. All this stress can cause confusing feelings. All these feelings are normal. Even scary feelings are OK. Why is the alcohol problem a secret? It doesn t have to be a secret but sometimes people don t want to let others know about their alcohol problem. They may worry that others will think badly of them and treat them differently. This is sometimes called stigma or discrimination. Drinking is often seen as something that people should be able to control, or to stop if they want to. People may worry that others would see them as weak if they admitted having an alcohol problem. People may also worry that if they admit they have a problem, it may lead to other problems (for example, that it may make them lose their job, scare family members or make others think they are a bad parent). Sometimes kids think that if they talk about their mom or dad s drinking problem, they will get their parent in trouble. They may also worry about getting in trouble themselves. Kids might feel that their family is different from others (for example, there may be a lot of arguing, the house may be a mess or the parent may often be sleeping on the couch). A child might be embarrassed by what is going on at home, and not want anyone to know about it. Can my mom or dad stop drinking so much? Can people get better? Yes. The good news is that people with alcohol problems can get better. However, it can be really hard to stop drinking. A person may take a long time to change. Or they might change for a while, but then have a day or week when they start drinking again. This is called a relapse, and it is often part of getting better. It doesn t always mean the person won t ever stop. Is there anything I can do to make my mom or dad better? Many kids worry about the parent with the alcohol problem. Family support is really important for people with a drinking problem. Kids can let their parent know they care about them and want them to get better, but ultimately it is the adults who are responsible for being the helpers, not the kids. Sometimes the parent may blame others for his or her drinking. But kids are not the

13 cause of their parent s drinking problem, no matter what is going on at home. The child can t control Substance or cure the Misuse problem. Grade 8 Why do people drink so much when they know it will hurt them or others? When people have an alcohol problem, they may lie and say things they don t mean, which can really hurt people s feelings. People may not admit the bad things that are happening in their lives (either to themselves or to others) because of their drinking. When someone is drunk, his or her judgment is off, or impaired. The person may do dangerous things, such as driving or getting into fights. People with a drinking problem believe alcohol will help them feel better or forget about their other problems. People who drink too much usually only focus on what is happening right now. They do not think about what may happen later or in the long term. They may not be able to understand what is really going on in their lives. People who have been drinking too much for a long time may drink to avoid feeling ill. They may feel ill if they stop drinking or drink less, and this feels worse in the short term. When I grow up, will I have an alcohol problem too? It s natural to worry about this. Some scientists think that kids may be more likely to have an alcohol problem if a parent does. But this is not certain, and most kids will not follow in their parent s footsteps and have a drinking problem. Most adults drink responsibly and don t develop alcohol problems. Kids are able to make different choices. It helps if kids know the risks. They can get support to help them make different choices than their parent did. What can I do so that I don t ever have an alcohol problem? There are a lot of things kids can do. Joining clubs, playing sports and hanging out with friends are all great ideas. So is spending time with other adults who don t have problems with alcohol (for example, sports coaches, teachers and other grown-up relatives). It s important for kids to find something they enjoy and to spend a lot of time doing it. It s good to spend time with other kids who like to play sports and do fun and healthy things (for example, ride bikes, play in the playground, do arts and crafts, and play on the computer). These are all great ways to cope with stress, sadness, and ups and downs. Kids should also find things they like to do alone, for when they can t leave the house or find someone to play with. For example, they can read, write stories, play music or watch TV. They can also talk to a friend on the phone. If kids have their own dreams and goals, they are less likely to have an alcohol problem. Adults can help kids work toward goals. It s important for kids to have a relationship with at least one caring adult. When things in the family are going well, it s a good idea for kids to join in family celebrations and rituals. These can be small things, like eating dinner together, watching a TV show

14 together or celebrating birthdays and holidays together in a special way. This is important for kids, even Substance when not everyone Misuse in the Grade family is there. 8 Lower-Risk Cannabis Use Guidelines Body image and substance misuse There is a link between eating disorders and substance misuse. Youth who engage in disordered eating are more likely to misuse substances. The reverse is also true. Substance abuse and eating disorders can exist together. In addition, both of these problems can overlap with other mental health problems. Outward signs of substance use or withdrawal that mirror those related to an eating disorder include:

15 Substance cognitive and Misuse emotional Grade symptoms 8 such as irritability and anxiety; and physical symptoms such as shaking, seizures, headaches and body aches. The physical symptoms listed above can be the result of either starvation or intoxication. Youth who suffer from anorexia nervosa might also have rapid or irregular heartbeats, as might an individual who is using stimulants. For these reasons, assessments are needed for both problems since the presence of one disorder can mask the other. Eating disorders occur across gender and demographic groups; however, eating disorders tend to be more common in females. Eating disorders and substance misuse are often linked with mental illness (i.e. depression, anxiety, PTSD). Societal views may also contribute to body image issues. Media tends to portray ideal body shape as being thin. Body image issues can lead to abuse of supplements, vitamins, steroids, and other substances. Examples: Stimulants may be used to suppress appetite. Laxatives may be used for purging (i.e. Bulimia nervosa) Steroids for building muscle Consequences of abusing substances to change physical appearance include: Stress dehydration irritability aggressiveness mood swings acne change in sex organs hair loss organ damage addiction

16 Stress is the body s response to a real or perceived threat that is meant to prepare a person for some Substance kind of action Misuse to avoid danger. Grade Most 8 of the threats people face are not something that they can fight or run away from; they are problems that they have to work through. Some stress can be a good thing because it motivates us to focus on a task or take action and solve a problem. In this situation, stress is manageable and even helpful. When stress is unhelpful, people may feel overwhelmed or feel like they cannot possibly fix the problem. In these cases, some people avoid dealing with the original problem altogether, which may make the problem, and stress, worse. It can be very hard to concentrate, make decisions, and feel confident when a person experiences a lot of stress. Physical signs of stress include sweating, a racing heart, or tense muscles. Over time, stress can also have a big impact on physical health. Sleep difficulties and headaches are common problems related to stress. People are also more likely to get sick when they re experiencing a lot of stress. Stress is a reaction to a situation it is not about the actual situation. We usually feel stressed when we think that the demands of the situation are greater than our resources to deal with that situation. How to manage stress Identify the problem. Is your job, school, a relationship with someone, or worries about money causing stress? Identifying the real problem allows you to do something about it. Solve problems as they come up. What can you do and what are the possible outcomes? Would that be better or worse than doing nothing? Remember, sometimes solving a problem means doing the best you can, even if it is not perfect, or asking for help. Once you have decided on a solution, divide the steps into manageable pieces and work on one piece at a time. Talk about your problems. Sometimes it is helpful to talk about your stress. Family members or friends may be able to help by just listening (simply expressing your feelings can help a lot) or they may have ideas to help you solve or deal with your problems. If you need to talk with someone outside your own circle of loved ones, your school or family doctor may be able to refer you to a counselor.

17 Simplify your life. Stress can come up when there are too many things going on. Learning to say no Substance is a real skill that Misuse takes practice. Grade Try to 8 look for ways to make your to-do list more manageable. Learn helpful thinking strategies. The way you think about situations affects the way you respond to them. Having unhelpful thoughts, such as believing that everything must be perfect or expecting the worst possible outcome, can make problems seem bigger than they really are. Learn about stress management. There are many useful books, websites, and courses to help you cope with stress. There are also counselors who specialize in stress. Start on the inside. Practices like yoga, meditation, mindfulness, prayer, or breathing exercises can help you quiet your mind and look at problems from a calmer, more balanced point of view. With time, these practices can help you manage your response to stressful situations as they come up. Get active. Physical activity can be a great way to reduce stress and improve your mood. Do something you enjoy. Making time for hobbies, sports, or activities that you find fun or make you laugh can temporarily give you a break from problems. Listen to music, read, go for a walk, see a friend, watch your favourite movie, or do whatever makes you feel good. The goal of stress management is to bounce back from problems or challenges and maintain wellness.

18 Resources Centre for Addiction and Mental Health (CAMH) Information for Children and Youth ( Talking to Kids About Drugs (Niagara Region) Contains links to other resources for teachers and parents ( Community Addictions Services of Niagara Region ( Pathstone Mental Health ( Mind Your Mind (

19 References Centre for Addiction and Mental Health (CAMH) Information for Children and Youth ( Canada s Lower-Risk Cannabis Use Guidelines (2017) ( ckgrounders/current_year/pages/public-health-guidelines-aim-to-lower-health-risks-of-cannabisuse.aspx?hootpostid=922ae45ea44be3ac039cf8d37c539c48) Cannabis in Canada - Get the Facts! ( Current Cannabis Laws - Government of Canada ( The Chief Public Health Officer s Report on the State of Public Health in Canada 2015: Alcohol Consumption in Canada ( etat-sante-publique-alcool/alt/state-phac-alcohol-2015-etat-aspc-alcool-eng.pdf) Ontario Student Drug Use and Health Survey (OSDUHS) 2015 ( National Institute of Drug Abuse ( Drug Free Kids ( Canadian Public Health Association (

20 Canadian Centre on Substance Abuse ( en.pdf) Eating Disorders and Substance Abuse - Canadian Centre on Substance Abuse ( en.pdf)